Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. Some, use the terms interchangeably. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems, a fast heartbeat, heat intolerance, enlargement of the thyroid, hand tremor, weight loss. Symptoms are less severe in the elderly and during pregnancy. An uncommon complication is thyroid storm in which an event such as an infection results in worsening symptoms such as confusion and a high temperature and results in death; the opposite is hypothyroidism. Graves' disease is the cause of about 50% to 80% of the cases of hyperthyroidism in the United States. Other causes include multinodular goiter, toxic adenoma, inflammation of the thyroid, eating too much iodine, too much synthetic thyroid hormone. A less common cause is a pituitary adenoma.
The diagnosis may be suspected based on signs and symptoms and confirmed with blood tests. Blood tests show a low thyroid stimulating hormone and raised T3 or T4. Radioiodine uptake by the thyroid, thyroid scan, TSI antibodies may help determine the cause. Treatment depends on the cause and severity of disease. There are three main treatment options: radioiodine therapy and thyroid surgery. Radioiodine therapy involves taking iodine-131 by mouth, concentrated in and destroys the thyroid over weeks to months; the resulting hypothyroidism is treated with synthetic thyroid hormone. Medications such as beta blockers may control the symptoms, anti-thyroid medications such as methimazole may temporarily help people while other treatments are having effect. Surgery to remove the thyroid is another option; this may be used in those with large thyroids or when cancer is a concern. In the United States hyperthyroidism affects about 1.2% of the population. It occurs between two and ten times more in women. Onset is between 20 and 50 years of age.
Overall the disease is more common in those over the age of 60 years. Hyperthyroidism may be present with significant symptoms; some of the symptoms of hyperthyroidism include nervousness, increased perspiration, heart racing, hand tremors, trouble sleeping, thinning of the skin, fine brittle hair, muscular weakness—especially in the upper arms and thighs. More frequent bowel movements may occur, diarrhea is common. Weight loss, sometimes significant, may occur despite a good appetite, vomiting may occur, for women, menstrual flow may lighten and menstrual periods may occur less or with longer cycles than usual. Thyroid hormone is critical to normal function of cells. In excess, it both overstimulates metabolism and disrupts the normal functioning of sympathetic nervous system, causing "speeding up" of various body systems and symptoms resembling an overdose of epinephrine; these include fast heart beat and symptoms of palpitations, nervous system tremor such as of the hands and anxiety symptoms, digestive system hypermotility, unintended weight loss, a lower and sometimes unusually low serum cholesterol.
Major clinical signs include weight loss, heat intolerance, hair loss, muscle aches, fatigue, irritability, high blood sugar, excessive urination, excessive thirst, tremor, pretibial myxedema, emotional lability, sweating. Panic attacks, inability to concentrate, memory problems may occur. Psychosis and paranoia, common during thyroid storm, are rare with milder hyperthyroidism. Many persons will experience complete remission of symptoms 1 to 2 months after a euthyroid state is obtained, with a marked reduction in anxiety, sense of exhaustion and depression; some individuals may have an increased rate of anxiety or persistence of affective and cognitive symptoms for several months to up to 10 years after a euthyroid state is established. In addition, those with hyperthyroidism may present with a variety of physical symptoms such as palpitations and abnormal heart rhythms, shortness of breath, loss of libido, nausea, diarrhea and feminization. Long term untreated hyperthyroidism can lead to osteoporosis.
These classical symptoms may not be present in the elderly. Neurological manifestations can include tremors, myopathy, in some susceptible individuals periodic paralysis. An association between thyroid disease and myasthenia gravis has been recognized; the thyroid disease, in this condition, is autoimmune in nature and 5% of people with myasthenia gravis have hyperthyroidism. Myasthenia gravis improves after thyroid treatment and the relationship between the two entities is not well understood. In Graves' disease, ophthalmopathy may cause the eyes to look enlarged because the eye muscles swell and push the eye forward. Sometimes, one or both eyes may bulge; some have swelling of the front of the neck from an enlarged thyroid gland. Minor ocular signs, which may be present in any type of hyperthyroidism, are eyelid retraction, extraocular muscle weakness, lid-lag. In hyperthyroid stare the eyelids are retracted upward more than normal (the normal position is at the superior corneoscleral
The Democratic People's Republic of Korea calendar, DPRK calendar, or Juche calendar, named after the Juche ideology, is the system of year-numbering used in the Democratic People's Republic of Korea. The calendar borrows elements from two historical calendars used in Korea, the traditional system of Korean era names and the Gregorian calendar in which years are tied to the traditional birth of Jesus. In contrast to these two, the Juche calendar begins with the birth of the founder of the Democratic People's Republic, Kim Il-sung; the decree on the Juche calendar was adopted on 8 July 1997, on the third anniversary of the death of Kim Il-sung. The same decree designated the birth anniversary of Kim Il-sung as the Day of the Sun; the birth year of Kim Il-sung, 1912 in the Gregorian calendar, became "Juche 1" in the North Korean calendar. Thus, the current year 2020 is "Juche 109", the next year 2021 will be "Juche 110", so on; this was done as a means of advancing Kim Il-sung's cult of personality.
The calendar began to be implemented on the Day of the Foundation of the Republic. On that date, news agencies, radio stations, public transport, birth certificates began to use Juche years; the year 1912 is "Juche 1" in the North Korean calendar. There are no "before Juche 1" years, years before 1912 are given numbers based on the Christian calendar only. Ranges of years that begin before 1912 and end after it are given in Christian calendar numbers only. Any other years after 1912 will be given in either Juche years only, or in Juche years and the corresponding year in the Christian calendar in parentheses. In material pertaining to relations with foreign countries, "the Juche Era and the Christian era may be used on the principles of independence and reciprocity." Example of "103" from Pyongyang University of Science and Technology. Public holidays in North Korea Minguo calendar, which has the same starting year based on the founding of the Republic of China
John Bulkeley was an English politician who sat in the House of Commons at various times between 1640 and 1662. Bulkeley was the son of William Bulkeley of Burgate and his wife Margaret Culliford, daughter of John Culliford of Encombe, Dorset, he matriculated at Hart Hall, Oxford on 13 April 1632, aged 18. He was a student of the Middle Temple in 1633, he travelled abroad in France from 1634 to 1637. In April 1640, Bulkeley was elected Member of Parliament for Yarmouth in the Short Parliament, he was elected to the Long Parliament in November 1645 as MP for Newtown until he was excluded under Pride's Purge. Bulkeley was elected MP for Hampshire in 1654 for the First Protectorate Parliament and was re-elected for Hampshire in 1656 for the Second Protectorate Parliament. In 1659 he was elected MP for in the Third Protectorate Parliament and in 1660 was chosen again for Hampshire in the Convention Parliament, he was lastly elected MP for Lymington in the Cavalier Parliament and sat until his death in 1662.
Bulkeley died at the age of 47. Bulkeley married firstly by licence dated 4 January 1638, Anne Doddington, daughter of Sir William Doddington of Breamore and had two daughters, he married secondly after settlement dated June 1646, Elizabeth Trenchard widow of Francis Trenchard of Cutteridge and daughter of William Sotwell of Greenham, Berkshire. She died in March 1651 and he married thirdly after settlement dated 1652, Penelope Trenchard, daughter of Sir Thomas Trenchard of Wolverton and had three sons